Blower A L
Royal Infirmary, Wigan, UK.
Scand J Rheumatol Suppl. 1996;105:13-24; discussion 25-7. doi: 10.3109/03009749609097232.
Although therapeutically beneficial, nonsteroidal anti-inflammatory drugs are associated with serious gastrointestinal side effects, including ulceration, hemorrhage, and perforation. Endoscopic studies indicate that up to 30% of chronic NSAID users will develop gastroduodenal ulceration. Various case-control studies have reported an association between ulcer-related complications or deaths and NSAID use. An imprecise correlation has been found to exist between the presence of NSAID-induced gastrointestinal damage and symptoms, such as dyspepsia and pain. It is now thought that the major deleterious effects of NSAIDs on the gastrointestinal tract are related to the ability of systemically absorbed NSAIDs to alter gastric and duodenal defense mechanisms, primarily via inhibition of mucosal prostaglandin synthesis. Although various therapeutic agents have been investigated for their ability to prevent NSAID-induced ulcers, only the prostaglandin analogue misoprostol has been shown to significantly reduce the incidence of both gastric and duodenal ulcers in NSAID users. Recently, the Misoprostol Ulcer Complications Outcomes Safety Assessment trial demonstrated that misoprostol also reduces the most serious complications of NSAID-induced ulcers, namely bleeding, perforation, and gastric outlet obstruction.
尽管非甾体抗炎药具有治疗益处，但它们与严重的胃肠道副作用相关，包括溃疡、出血和穿孔。内镜研究表明，高达30%的慢性非甾体抗炎药使用者会发生胃十二指肠溃疡。各种病例对照研究报告了溃疡相关并发症或死亡与使用非甾体抗炎药之间的关联。已发现非甾体抗炎药引起的胃肠道损伤与消化不良和疼痛等症状之间存在不精确的相关性。现在认为，非甾体抗炎药对胃肠道的主要有害作用与全身吸收的非甾体抗炎药改变胃和十二指肠防御机制的能力有关，主要是通过抑制粘膜前列腺素合成。尽管已经研究了各种治疗药物预防非甾体抗炎药引起的溃疡的能力，但只有前列腺素类似物米索前列醇已被证明能显著降低非甾体抗炎药使用者胃和十二指肠溃疡的发生率。最近，米索前列醇溃疡并发症结局安全性评估试验表明，米索前列醇还能减少非甾体抗炎药引起的溃疡最严重的并发症，即出血、穿孔和胃出口梗阻。
